If you are currently serving in the military or you are a veteran, you are more likely to be a cigarette smoker than a civilian is. The likelihood is even greater if you are (or have been) deployed overseas. It is also very likely that you picked up this habit after enlisting. According to a Department of Defense report, 38 percent of the service members who smoke picked up the habit after enlisting.

This trend is not by chance. Smoking has deep roots in our military culture. It began in April 1917, when the American Expeditionary Force marched off to join other Allied powers in the fight against Germany in World War I. Carried with them was their tobacco ration. Cigarettes soon became a way for soldiers to deal with the stress of battle and escape from the boredom of downtime. Cigarettes even became a form of barter – as valuable as currency. Young soldiers and sailors away from home for the first time discovered cigarettes as a connecting rod in forming a new social order. Some 20 years later, as the U.S. entered World War II, cases of lung cancer were on the rise from smokers who picked up their habit during WWI. Name-brand cigarettes were now being sent to the soldiers and sailors at no charge and added to K-rations and C-rations.

As war ended in 1945, another generation of young people were on their way home, bringing cigarette addiction with them. The smoking trend continued to grow. By 1949, more than 50 percent of men and nearly 33 percent of women now smoked.

During the Korean War, in the face of mounting evidence of the adverse health effects of smoking, the military continued to provide free cigarettes, a practice that would continue during the Vietnam conflict, ending in 1975. Today, members of the United States military continue to smoke at above-average rates, despite its leaders’ policy goal to become smoke-free in order to enhance fitness and military readiness and curb hospitalization and smoking-related disease.

For many, smoking continues to be seen as a common bond for members of an exclusive group, part of an entrenched social norm. Supporting that mindset are tobacco companies that invest mightily to keep that smoking culture alive today.

A recent campaign by the Truth Initiative, a nonprofit organization “dedicated to smoking cessation among youth and young adults,” revealed “tobacco industry documents made public as evidence in litigation,” according to HowStuffWorks.com. Within the documents, they uncovered internal tobacco industry references to members of the U.S. military as “the plums that are here to be plucked.”

What are the results of the tobacco industry’s harvest? Smoking costs the Department of Defense more than $1.6 billion per year, taking into account tobacco-related hospitalization, medical care and lost workdays. For far too many young men and women, military service has left them with an unshakable addiction to a substance that has been found to harm nearly every organ system in the body. According to the Centers for Disease Control and Prevention, more Americans have died from smoking than in all the wars the United States has fought.

I was reminded of the power of this strong military smoking culture and the role of peer influence and social acceptability – as well as Big Tobacco’s role in stoking it – in thinking about the current epidemic in e-cigarette use among middle and high school students. According to data from the Food and Drug Administration and the CDC, between 2011 and 2018, nearly 21 of every 100 high school students surveyed reported e-cigarette use in a 30-day period. From 2017 and 2018, there occurred the biggest one-year spike in usage of any kind in the 44 years of monitoring substance abuse by young people.

What we are learning is that teenagers do not see “vaping” an e-cigarette as harmful. The majority of teenagers vape for the flavors, not realizing that they are inhaling nicotine, a highly addictive substance. Many teenagers picking up an e-cigarette have never smoked a traditional cigarette and now, according to current research, have become four times more likely to do so. This current trend has been successful in putting nicotine in every classroom across America. As we were recently reminded by a U.S. Surgeon General report, in just over a year, this substance’s rate of use has doubled.

While it is true that nicotine is not the major cause of tobacco-related disease, it is the addictive chemical in both tobacco and e-cigarettes that binds the user to the product. At its worst, it can create an addiction where some lose their capacity to make a free choice. It seems clear that e-cigarette use among young people is associated with a progression toward greater cigarette use.

As I said last week, the recent announcement by Altria, the leading U.S. cigarette manufacturer and parent company of Philip Morris, should make clear the nexus between traditional cigarettes and e-cigarettes. The company recently announced it is making a $12.8 billion investment in e-cigarette maker Juul and plans to aggressively help promote the e-cigarette brand. This investment gives the tobacco industry direct access to a new pipeline of millions of young e-cigarette users and a growth market for their tobacco products.

If Big Tobacco is expert in anything, it is how to surgically aim alluring advertising and packaging at young people and capitalize on trends to reap new lifelong customers. If we are to be successful in combating the public health threat this vaping epidemic represents, then media messages must begin to offer a different social perception: from “Smoking e-cigarettes is cool” to “You are being played.”